Objective To explore the clinical efficacy of anterior surgery and posterior surgery for thoracolumbar burst fractures.Methods 87 patients with unstable burst fractures who had undergone surgical treatment during the period of June 2006 to June 2010 in our hospital were enrolled in this study.The patients were divided into posterior surgery group and anterior surgery group.The efficacy was assessed according to radiographic changes and neurological functional status.Results After treatment,the average kyphostic angle reduced from ( 15 ± 8 ) ° to ( 4 ± 2 ) ° in the posterior surgery group,with a significant statistical difference ( P＜ 0.05 ); however,the angle returned to ( 12 ± 8 ) degrees at the end of follow-up.In the anterior group,the average kyphostic angle reduced from ( 16 ± 11 ) ° to ( 6 ± 4 ) °,with a statistical difference( P＜ 0.05 ),no obvious loss of the angle occurred.The improvement in neurological function was slightly better in the anterior group than in the posterior surgery group.Conclusions Both anterior and posterior surgery has a better efficacy.Anterior surgery does not cause a marked loss of the angle.The surgical procedure should be selected based on the actual conditions in patients with fractures.